Regional blood flow and oxygen uptake of the lower limbs were studied in 11 patients with arterial insufficiency (10 with severe unilateral, 1 with bilateral intermittent claudication). Regional muscle blood flow (F), oxygen consumption rate (R), and oxygen extraction fraction (E) were evaluated by positron emission tomography (PET) and bolus inhalation of C15O2 and 15O2 by the patient. Tomograms were recorded at the greatest diameter of legs, at rest and ten minutes after a treadmill walk test leading to the development of ischemic pain in the affected leg. In 5 patients, F and E were correlated with the results of occlusive venous strain gauge plethysmography and with the measurements of blood gases in one brachial artery and in the femoral vein of the affected limb. Blood flow values measured at rest and after exercise by PET were poorly correlated with the plethysmographic findings. This may be because PET does not interfere with flow as venous occlusion plethysmography does in low peripheral pressure conditions. The results show that F, R, and E were not significantly different in normal and pathologic legs at rest. The values of F and R were significantly higher in pathologic than in normal lower limbs, ten minutes after exercise, whereas E was not significantly altered by exercise at any side. This suggests that, during the recovery from a walk test, the delayed increase in oxygen uptake is proportional to the delayed hyperemia in the ischemic muscles ("oxygen debt") and probably not linked to a luxury perfusion.

The authors studied muscular blood flow (F), oxygen consumption rate (R), and oxygen extraction fraction (E) in 5 patients suffering from severe intermittent claudication (stage II). They applied the bolus technique of H2150 and 1502 with a detection by positron emission tomography (PET). Tomograms were recorded at the greatest diameter of the calves, at rest and ten minutes after a treadmill walk test leading to the development of ischemic pain in the affected extremity. F and E data were compared with the values obtained by more usual methods, namely occlusive venous strain gauge plethysmography and femoral venous blood sampling. During the study, these patients received naftidrofuryl, a vasodilatator drug, in an intravenous dose of 600 mg diluted in 250 mL saline infused over a six-hour period in a placebo-controlled, double-blind, crossover protocol (two consecutive experiments, a week apart). The results showed that all blood flow values measured at rest and after exercise by PET were in close correlation (r = 0.71) with the plethysmographic findings. The agreement between the two methods of measuring blood flow was less obvious with an Altman's presentation of the data: there was a tendency to measure higher values with PET scan. Concerning E, the correlation was poor at rest. After exercise, the values were more elevated with PET and no correlation was found with blood samples. The authors found no significant effect of naftidrofuryl either on flow or metabolic data.

Postischemic hyperemia was studied in normal and pathologic limbs by an isotopical method, which measures the delay and the rate of appearance of tagged serum-albumin in the foot after release of an arterial femoral occlusion (T in seconds). The postexercise hyperemia was assessed by the follow-up of the ankle arterial pressure drop (deltaP). deltaP was positively correlated to the logarithm of T in the absence of proximal arterial lesions. The correlation vanished in the presence of an aortoiliac occlusive disease. Therefore we conclude that the isotopical test can be used to assess selectively the capacity of hyperemia of the arterial network below the inguinal ligament.

The pressure external to the calf was increased suddenly in 11 normal subjects and the resulting change in calf volume (considered to be mainly a change of calf vein blood volume) was followed using a mercury-in-rubber strain gauge. For a small increase of pressure the volume decreased exponentially and increased linearly when the pressure was suddenly released. A simple theory was developed which treats the calf veins as a single volume with a single compliance and a single outflow resistance. Using the theory, the following average results were obtained from measured values: effective venous compliance 1-1%kPa (SD 0.3); effective venous outflow resistance 3.8 s kPa/% (SD 1-3); and total flow into the veins from themicrocirculation 0.054%/s (SD 0.020) (% refers to a change in volume expressed as a percentage of the initial volume of the calf). The significance of the findings is considered with special reference to the occurrence of calf vein thrombosis.

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